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Acta Orthop. Aug 7, 2009; 80(4): 465–471.
Published online Aug 1, 2009. doi:  10.3109/17453670903110659
PMCID: PMC2823188
Additive fiber-cerclages in proximal humeral fractures stabilized by locking plates
No effect on fracture stabilization and rotator cuff function in human shoulder specimens
Christine Voigt,corresponding author1 Christof Hurschler,3 Louise Rech,1 Rolf Vosshenrich,2 and Helmut Lill1
1Department of Trauma and Reconstructive Surgery, , , Germany
2Institute of MRI Diagnostics, Diakoniekrankenhaus Friederikenstift gGmbH, , Germany
3Laboratory of Biomechanics and Biomaterials, Department of Orthopedic Surgery, Hannover Medical School, Hannover, Germany
corresponding authorCorresponding author.
Correspondence CV: christine.voigt/at/
Received July 16, 2008; Accepted February 6, 2009.
Background and purpose The effect of additive fiber-cerclages in proximal humeral fractures stabilized by locking plates on fracture stabilization and rotator cuff function is unclear. Here it was assessed in a human cadaver study.
Methods 24 paired human shoulder specimens were harvested from median 77-year-old (range 66–85) female donors. An unstable 3-part fracture model with an intact rotator cuff was developed. 1 specimen of each pair received an additive fiber-cerclage of the rotator cuff after plate fixation, and the other one received a plate fixation without an additive fiber-cerclage. Force-controlled hydraulic cylinders were used to simulate physiological rotator cuff tension, while a robot-assisted shoulder simulator performed 4 relevant cases of load: (1) axial loading at 0°, (2) glenohumeral abduction at 60°, (3) internal rotation at 0° abduction, and (4) external rotation at 0° abduction, and imitated hanging arm weight during loading without affecting joint kinematics. A 3-dimensional real-time interfragmentary motion analysis was done in fracture gaps between the greater tuberosity and the head, as well as subcapital. The capacity of the rotator cuff to strain was analyzed with an optical system.
Results Interfragmentary motion was similar between the groups with and without fiber-cerclages, in both fracture gaps and in any of the cases of load. Cerclages did not impair the capacity of the rotator cuff to strain.
Interpretation Provided that unstable 3-part fractures are reduced and stabilized anatomically by a locking plate, additive fiber-cerclages do not reduce interfragmentary motion. Additive fiber-cerclages may be necessary in locking plate osteosyntheses of multiple-fractured greater tuberosities or lesser tuberosity fractures that cannot be fixed sufficiently by the plate.
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